Cardiac Magnetic Resonance Shows Improved Outcomes in Patients with an ST-Segment Elevation Myocardial Infarction and a High Thrombus Burden Treated with Adjuvant Aspiration Thrombectomy

Abstract

There is a discrepancy between epicardial vessel patency and microcirculation perfusion in a third of patients treated with percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI). Optimization with aspiration thrombectomy (AT) may reduce distal embolization and microvascular obstruction. The effect of AT in the treatment of STEMI is debatable. The purpose of this study was to use cardiac magnetic resonance (CMR) to determine whether AT influences microvascular obstruction (MVO), infarct size and left ventricular (LV) remodelling in STEMI patients. Sixty STEMI patients with a thrombus-occluded coronary artery were randomized in a 2:1 fashion to receive PCI proceeded by AT (AT + PCI group), or PCI only. MVO, myocardial infarct size and LV remodelling were assessed by CMR during the index hospitalization and 6 months thereafter. The majority of patients had a large thrombus burden (TIMI thrombus grade 5 in over 70% of patients). PCI and AT were effective in all cases. There were no periprocedural strokes. CMR showed that the addition of AT to standard PCI was associated with lesser MVO when indexed to the infarct size and larger infarct size reduction. There were less patients with left ventricle remodelling in the AT + PCI vs. the PCI only group. To conclude, in STEMI patients with a high thrombus burden, AT added to PCI is effective in reducing infarct size, MVO and LV remodelling.

A Non-Coronary, Peripheral Arterial Atherosclerotic Disease (Carotid, Renal, Lower Limb) in Elderly Patients—A Review: Part I—Epidemiology, Risk Factors, and Atherosclerosis-Related Diversities in Elderly Patients

“…Intravascular imaging tools such as optical coherence tomography (OCT) and intravascular ultrasound (IVUS), as well as imaging of the atherosclerotic plaque using CT angiography (CTA) and magnetic resonance angiography (MRA), allow us to detect the coexistence of atherosclerotic lesions at various stages of development in an individual patient [ 49 , 50 , 51 , 52 , 53 ]. Necrotic lipid changes in atherosclerotic plaques, which may be ulcerated or even micro-ruptured, are not uncommon and may heal over time.…”

The role of microvascular obstruction and intramyocardial hemorrhage in reperfusion injury to the heart

“…Ремоделирование ЛЖ, которое определяли как увеличение конечного диастолического объема ЛЖ на ≥10 % от исходного уровня спустя 4 месяца после ИМпST и ЧКВ, чаще наблюдалось у пациентов с МВО [68]. По данным МРТ, аспирационная тромбэктомия перед ЧКВ уменьшала размеры инфаркта, площадь МВО и ремоделирование ЛЖ у больных ИМпST c высокой тромботической нагрузкой [18]. Однако M.I.…”

“…Возможна и другая зависимость -чем больше зона МВО, тем больше размер инфаркта. Сообщалось, что площадь МВО составляет 1,9-5,4 % от массы левого желудочка (ЛЖ) у больных ИМпST и ЧКВ по данным МРТ [4,11,[16][17] или 22 % от площади инфаркта [18]. По данным M.I.…”

“…Zia et al, площадь МВО, измеренная с помощью МРТ, составляет 3,1 % от площади миокарда [19]. У больных ИМпST и МВО по данным МРТ размер инфаркта равнялся 13-32 % от массы ЛЖ после ЧКВ [11,18,20…”

The Role of Microvascular Obstruction and Intra-Myocardial Hemorrhage in Reperfusion Cardiac Injury. Analysis of Clinical Data

“…Consequently, infarct size and the duration of ischemia are predictors of the development of MVO. It was reported that the MVO area is 1.9–5.4% of left ventricular (LV) mass in patients with STEMI and PCI according to MRI [ 11 , 16 , 17 , 18 , 19 ] or 22% of the infarcted myocardium [ 20 ]. According to Zia et al .…”